Method and apparatus to monitor patients and treat with intraosseous fluids

ABSTRACT

Automatic external defibrillator apparatus may be provided for use in cooperation with an intraosseous apparatus. Apparatus and methods may also be provided to execute protocols calling for external defibrillation and drug delivery. The disclosure provides a medical apparatus including two electrodes, a processor, a display, a driver, a drug delivery slot, a drug delivery port, and a voltage source. The two electrodes may include an attachment operable to releasably connect the two electrodes to the patient. The processor may be operable to collect and analyze a rhythm associated with the patient&#39;s heart from the two electrodes. The display may be operable to communicate instructions to a user. The driver may be operable to insert an intraosseous device into a bone and associated bone marrow of the patient. The drug delivery slot may be operable to receive a drug. The drug delivery port may be operable to communicate the drug from the drug delivery slot to the patient via the intraosseous device. The voltage source may be operable to deliver an electric shock to the patient via the two electrodes.

RELATED APPLICATION

This application claims the benefit of provisional patent applicationentitled “SMART PARAMEDIC,” Provisional Application Ser. No. 60/938,501filed May 17, 2007. The contents of this application is incorporatedherein in its entirety by this reference.

TECHNICAL FIELD

The present disclosure is related to apparatus and methods which may beused to communicate fluids with a patient's vascular system via anintraosseous device in cooperation with an automatic externaldefibrillator.

BACKGROUND OF THE DISCLOSURE

Automatic external defibrillators (AEDs) are increasingly common due toconcerted campaigns to equip locations with large numbers of people,such as airports, schools, churches, office building, and/or othergathering locations. In addition, trained first responders are oftenequipped with AED kits. It is asserted that treatment with an AEDsignificantly increases a patient's chances of survival in the event ofcardiac arrhythmia.

According to the Federal Food and Drug Administration, an AED typicallycomprises adhesive electrode pads for connection with a patient, amicroprocessor for collecting and analyzing the rhythms associated witha patient's heart, and a source of voltage operable to deliver a shockthrough the electrodes in an attempt to correct an arrhythmia. Some AEDkits are more properly called semi-automatic, as they require users topress a button or other actuator in response to instructions by the AEDitself.

In most cases, an AED includes basic instructions for use in the event afirst aid provider is unfamiliar with the equipment. Such instructionsmay include pictures or text indicating proper attachment of theelectrodes and/or operation of the electronics in the kit. Some AEDs,once activated, operate independently by delivering any appropriateshock without further action by the user.

Those patient conditions treated with external defibrillation are oftenbetter treated with a combination of defibrillation and drugadministration. For instance, Advanced Cardiac Life Support (ACLS)protocol promulgated in the United States by the American HeartAssociation (AHA) provides a treatment protocol for cardiac conditions.The ACLS protocol may include external defibrillation, administration ofdrugs, and/or insertion of airway devices.

ACLS protocol may include delivery of any drug or medication, including,but not limited to, calcium, atropine, adenosine, amiodanone,epinephrine, bicarb, versed, and/or lidocaine. Delivery of drugs duringthe course of ACLS protocol may include repeated injections and/orinstalling a IV connection.

SUMMARY OF THE DISCLOSURE

In accordance with teachings of the present disclosure, apparatus andmethods may be provided to facilitate access to a patient's vascularsystem and to communicate fluids with the vascular system. Theseteachings may provide increased effectiveness in treatment of a patientin accord with an Automatic External Defibrillator.

Apparatus and methods incorporating teachings of the present disclosuremay be used to treat various patient conditions including, but notlimited to, cardiac arrest, ventricular fibrillation, pulselessventricular tachycardia, bradycardia and/or any other sort of cardiacarrhythmia. Installation of an IO device may offer improved access,increased fluid flow rates and numerous other benefits over IV fluiddelivery or repeated injections.

One aspect of the present disclosure may include providing apparatus andmethods for treating a patient including operating an automatic externaldefibrillator in cooperation with insertion of an intraosseous devicedisposed in a bone and associated bone marrow. Structures, apparatus andtechniques incorporating teachings of the present disclosure may be usedwith a wide variety of intraosseous devices.

Teachings of the present disclosure may be useful to establish vascularaccess during treatment at a wide variety of acute and chronicconditions at locations and facilities including, but not limited to,accident sites, emergency rooms, battlefields, emergency medicalservices (EMS) facilities, oncology treatment centers, and chronicdisease treatment facilities. Various teachings of the presentdisclosure may be used during treatment of animals in a veterinarypractice.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete and thorough understanding of the present embodimentsand advantages thereof may be acquired by referring to the followingdescription taken in conjunction with the accompanying drawings, inwhich like reference numbers indicate like features, and wherein:

FIG. 1 is a schematic drawing showing an isometric view of a powereddriver which may be used to place an intraosseous device at a selectedinsertion site;

FIG. 2 is a schematic drawing showing a side view of a manual driverwhich may be used to place an intraosseous device at a selectedinsertion site;

FIG. 3 is a schematic drawing in section and in elevation with portionsbroken away showing an exploded view of one example of an intraosseousdevice;

FIG. 4 is a schematic drawing showing an isometric view of theintraosseous device of FIG. 3 disposed in a container;

FIG. 5A is a drawing showing an isometric view with portions broken awayof a supporting structure and attachment mechanism installed at aninsertion site according to one embodiment of the current disclosure;and

FIG. 5B is a schematic drawing in section taken along line 5B-5B of FIG.5A showing an intraosseous device inserted into a bone and associatedbone marrow along with a supporting structure and attachment mechanismincorporating teachings of the present disclosure;

FIG. 6 is a schematic drawing in section showing one example of aconnector assembly which may be used to attach a fluid source, pressurepump, and tubing with an intraosseous device in accordance withteachings of the present disclosure;

FIG. 7 is a schematic drawing showing one embodiment of an automaticexternal defibrillator in accordance with teachings of the presentdisclosure;

FIGS. 8A and 8B are drawings showing one embodiment incorporating amethod of operating an automatic external defibrillator in accordancewith teachings of the present disclosure;

FIG. 9A is a schematic drawing showing an embodiment of an intraosseousdevice installation kit in accordance with teachings of the presentdisclosure;

FIG. 9B is a schematic drawing showing a close-up view of a portion ofan intraosseous device installation kit as depicted in FIG. 9A;

FIG. 10A is a schematic drawing showing an embodiment of an intraosseousdevice installation kit in accordance with teachings of the presentdisclosure;

FIG. 10B is a schematic drawing showing a close-up view of a portion ofan intraosseous device installation kit as depicted in FIG. 10A;

FIG. 11 is a schematic drawing showing an embodiment of an intraosseousdevice installation kit in accordance with teachings of the presentdisclosure;

FIG. 12 is a schematic drawing showing an embodiment of a combinedintraosseous device installation kit and automatic externaldefibrillator in accordance with teachings of the present disclosure;

FIGS. 13A and 13B are schematic drawings showing respective embodimentsof a drug cartridge for use in accordance with teachings of the presentdisclosure;

FIG. 14 a schematic drawing showing an embodiment of a combinedintraosseous device installation kit and automatic externaldefibrillator in accordance with teachings of the present disclosure;and

FIG. 15 is a flowchart showing a method of treating a patient inaccordance with teachings of the present disclosure.

DETAILED DESCRIPTION OF THE DISCLOSURE

Preferred embodiments of the disclosure and its advantages are bestunderstood by reference to FIGS. 1-15 wherein like numbers refer to sameand like parts.

Vascular access is often essential to viability of a patient inemergency situations, during transportation to a medical facility andduring treatment at the medical facility. Obtaining vascular access maybe a significant problem in five to ten percent of patients of all agesand weights in pre-hospital and hospital environments. This equates toapproximately six (6) million patients in the U.S. annually. For examplepatients suffering from conditions such as shock, cardiac arrest, drugoverdose, dehydration, diabetic coma, renal failure and altered statesof consciousness may have very few (if any) accessible veins.

In a hospital or similar medical facility, central line access is oftenan alternative to IV access. However, central line access generallytakes longer, costs more, may have a higher risk of complications andrequires skilled personnel to properly insert the central line. In manyhospital environments, nurses and physicians are increasingly turning tointraosseous (IO) access as an alternative to IV access, rather thancentral lines. In pre-hospital environments, paramedics and otheremergency medical service (EMS) providers are often finding that IOaccess may be quick, safe and effective when IV placement ischallenging.

Intraosseous (IO) access to bone and associated bone marrow has beenused for other procedures including, but not limited to, obtainingbiopsy specimens for analysis and research and also for bone marrowtransplantation and/or stem cell research.

Persons having ordinary skill in the art and practicing the teachings ofthis disclosure may be able to combine the benefits of an automaticexternal defibrillator (AED) with an IO installation kit and drugdelivery. For example, a combination device may provide automatic orsemi-automatic delivery of defibrillating shock and IO drugs asidentified by the ACLS protocol. In such cases, the combination devicemay include all the features of an AED as discussed in detail above aswell as instructions to users regarding installation of an IO device andautomatic or semi-automatic delivery of drugs as promulgated in the ACLSprotocol.

Teachings of the present disclosure may be satisfactorily used tocommunicate fluids with the intraosseous device at a wide variety oflocations. For example, apparatus and methods incorporating teachings ofthe present invention may be used to provide intraosseous access to apatient's vascular system in the sternum, the proximal humerus (theshoulder area), the proximal tibia (below the knee), and the distaltibia (above the inside of the ankle). Teachings of the presentdisclosure are not, however, limited to IO devices which may be insertedat the tibia, humerus, or sternum.

The upper tibia proximate a patient's knee or the humeral head proximatea patient's shoulder may be used as insertion sites for an IO device toestablish access with the patient's vascular system. Sternal access mayalso be used as an insertion site. Availability of multiple intraosseoussites has proven to be especially important in applications such asemergency treatment of battlefield casualties or other mass casualtysituation. Teachings of the present disclosure may be used at a widevariety of insertion sites.

The distal tibia is located just above the inside of the ankle. Thislocation may more readily provide vascular access to morbidly obesepatients. The distal tibia is usually a thinner area of the body. Usingthe distal tibia as an insertion site may allow emergency medicalservice personnel to pump medications and fluids into the body of obesepatients when regular conventional IV access is difficult. EMS personnelmay often not be able to start conventional IV infusions in obesepatients because their size may obscure many of the veins used forconventional access. Adipose tissue (fat) around other available IOaccess sites may be so thick that EMS personnel cannot reach the boneand associated bone marrow with available IO needles. In such cases,disposition of an IO needle in the distal tibia may offer a significantimprovement in vascular access to the overweight population.

The humeral head and sternum further provide insertion sites for anintraosseous device located above the diaphragm of a patient. Placing orinserting an intraosseous device above the diaphragm may be preferred bysome emergency room physicians and trauma surgeons for rapid vascularaccess.

Intraosseous access may also be used as a “routine” procedure withchronic conditions which substantially reduce or eliminate theavailability of conventional IV sites. Examples of such chronicconditions may include, but are not limited to, dialysis patients,seriously ill patients in intensive care units and epilepsy patients.Intraosseous devices along with supporting structure and/or monitoringequipment incorporating teachings of the present disclosure may bequickly and safely used to provide IO access to a patient's vascularsystem in difficult cases such as status epilepticus to give medicalpersonnel an opportunity to administer crucial medications and/orfluids. Further examples of such acute and chronic conditions are listednear the end of this written description. Insertion sites and associatedtarget areas for IO placement such as a patient's tibia, humerus, orsternum are often larger than insertion sites and associated targetareas for placement of an IV device making IO insertion easier than IVinsertion.

The term “driver” may be used in this application to include any type ofpowered driver or manual driver satisfactory for installing anintraosseous (IO) device such as a penetrator assembly or an IO needleinto a selected target site.

For some applications a powered driver or a manual driver may bedirectly coupled with an IO device. For other applications various typesof connectors may be used to couple a manual driver or a powered driverwith an IO device. A wide variety of connectors and associated connectorreceptacles, fittings and/or other types of connections with variousdimensions and configurations may be satisfactorily used to releasablyengage an IO device with a powered driver or a manual driver.

The term “intraosseous (IO) device” may be used in this application toinclude any hollow needle, hollow drill bit, penetrator assembly, bonepenetrator, catheter, cannula, trocar, inner penetrator, outerpenetrator, IO needle or IO needle set operable to provide access to anintraosseous space or interior portions of a bone. A wide variety oftrocars, spindles and/or shafts may be disposed within a cannula duringinstallation at a selected target area. Such trocars, spindles andshafts may also be characterized as inner penetrators. A cannula may becharacterized as an outer penetrator.

The term “fluid” may be used within this patent application to includeany liquid including, but not limited to, blood, water, salinesolutions, IV solutions, plasma or any mixture of liquids, particulatematter, dissolved medication and/or drugs appropriate for injection intobone marrow or other target sites. The term “fluid” may also be usedwithin this patent application to include body fluids such as, but notlimited to, blood, bone marrow and cells which may be withdrawn from atarget site.

Various features of the present disclosure may be described with respectto powered driver 10 and/or manual driver 10 a. Various features of thepresent disclosure may also be described with respect to intraosseousdevice-hub 60. However, intraosseous fluid delivery systemsincorporating teachings of the present disclosure may be satisfactorilyused with a wide variety of drivers and intraosseous devices. Thepresent disclosure is not limited to use with intraosseous device-hub 60or drivers 10 or 10 a.

FIG. 1 shows an embodiment of a powered driver 10 which may besatisfactorily used to insert an intraosseous device into a selectedtarget area or penetration site. Powered driver 10 may include housing12 with various types of motors and/or gear assemblies disposed therein(not expressly shown). A rotatable shaft (not expressly shown) may bedisposed within housing 12 and connected with a gear assembly (notexpressly shown). Various types of fittings, connections, connectorsand/or connector receptacles may be provided at one end of the rotatableshaft extending from end 14 of housing 12.

For some applications pin type fitting or connector 20 may be formed onthe one end of the rotatable shaft. A matching box type fitting orconnector receptacle may be provided on an intraosseous device so thatconnector 20 of powered driver 10 may be releasably engaged with theintraosseous device. For some applications, connector 20 may have apentagonal shaped cross section with tapered surfaces formed on theexterior thereof.

Handle 16 may include a battery (not expressly shown) or other powersource. Handle 16 may also include trigger assembly 18 for use inactivating powered driver 10. Examples of powered drivers are shown inpending patent applications Ser. No. 10/449,503 filed May 30, 2003entitled “Apparatus and Method to Provide Emergency Access To BoneMarrow,”now U.S. Pat. No. 7,670,328; Ser. No. 10/449,476 filed May 30,2003 entitled “Apparatus and Method to Access Bone Marrow, ” now U.S.Pat. No. 7,699,850; and Ser. No. 11/042,912 filed Jan. 25, 2005 entitled“Manual Intraosseous Device.”

FIG. 2 shows one example of a manual driver which may be satisfactorilyused to insert an intraosseous device into a selected target area. Forthis embodiment manual driver 10 a may be generally described as havinghandle 16 a with a “pistol grip” configuration. Handle 16 a has anergonomic design with finger grips 22 and one or more finger rests 24.

Connector 20 a may extend from first end 14 a of handle 16 a. Connector20 a may have a configuration and dimensions similar to previouslydescribed connector 20. However, manual drivers may be provided with awide variety of connectors and/or connector receptacles. Various detailsconcerning manual drivers are discussed in more detail in pending U.S.patent application Ser. No. 11/042,912 filed Jan. 25, 2005, entitled“Manual Intraosseous Driver.”

FIG. 3 is a schematic drawing showing an exploded view of one example ofa penetrator assembly which may be used to provide access to a patient'svascular system. Penetrator assembly or IO needle set 40 may includeconnector 30, hub 60 and cover 80. Connector 30 may be described ashaving a generally cylindrical configuration defined in part by firstend 31 and second end 32.

First end 31 may include opening 34 formed with various configurationsand/or dimensions. For some applications opening 34 may be sized toreceive portions of a drive shaft. One or more webs (not expresslyshown) may also be formed in first end 31 extending from opening 34.Open segments or void spaces (not expressly shown) may be formed betweensuch webs. Opening 34 and associated webs (if any) may be used toreleasably engage connector 30 with either a manual driver or a powereddriver.

The configuration and dimensions of opening 34 may be selected to becompatible with releasably engaging connector 30 of IO needle set 40 toconnector 20 of powered driver 10 or connector 20 a of manual driver 10a. For some applications metallic disk 35 may be disposed within opening34 for use in releasably engaging needle set 40 to a magnet (notexpressly shown) disposed on the end of connector 20 or 20 a.

For some applications exterior portion of connector 30 may include anenlarged tapered portion adjacent to first end 31. A plurality oflongitudinal ridges 33 may also be formed on the exterior of connector30 proximate first end 31. The enlarged tapered portion and/orlongitudinal ridges 33 may allow an operator to grasp associated IOneedle set 40 during attachment with a driver and may facilitatedisengagement of connector 30 from hub 60 after outer penetrator orcannula 70 has been inserted into a bone and associated bone marrow.

Second opening 36 may be formed in second end 32 of connector 30. Theconfiguration and dimensions of opening 36 may be selected to becompatible with releasably engaging the relevant portion of hub 60. Forexample threads 37 may be formed on interior portions of opening 36extending from second end 32. Threads 37 may be sized to engage threads67 formed on an exterior portion of hub 60. In addition, opening 36 mayinclude male luer slip 38, configured to correspond to female luer slip68 in hub 60. It should be noted that male luer slip 38 and female luerslip 68 do not come into physical contact when connector 30 and hub 60are connected. Threads 37 and 67 may be characterized as formingportions of a Luer lock connection. However, the present disclosure isnot limited to threads 37 and 67. Various types of releasableconnections including, but not limited to, other types of lockingconnections may be formed on adjacent portions of connector 30 and hub60.

Trocar or inner penetrator 42 may be securely engaged with connector 30extending from second end 32. The dimensions and configuration of innerpenetrator 42 may be selected to allow inner penetrator 42 to beslidably inserted into longitudinal bore 73 of outer penetrator orcannula 70. Trocar 42 may include first end or tip 44. The dimensionsand configuration of tip 44 may be selected to accommodate insertinginner penetrator 42 into bone and associated bone marrow at a selectedtarget area in a patient.

Hub 60 may include first end or distal end 61 and second end or proximalend 62. First end 61 may include any features selected to be compatiblewith connector 30. For example first end 61 of hub 60 may have agenerally cylindrical pin-type configuration compatible with releasablyengaging hub 60 with second end 32 of connector 30. As another example,hub 60 may include threads 67 formed adjacent to first end 61 of hub 60.Threads 67 may be compatible to be releasably engaged with threads 37formed on interior portions of opening 36 of connector 30.

For some applications first end 61 of hub 60 may be configured toaccommodate various connectors and/or to allow access for variousmethods of fluid delivery (e.g., a luer lock, a syringe, a standard IVconnection and/or a needle). For example, first end 61 of hub 60 mayinclude a check valve (not expressly shown), the check valve operable toallow fluid access via engaged luer lock connections and to restrictfluid access in the absence of an engaged luer lock connector. Inanother example, first end 61 of hub 60 may include a gasket (notexpressly shown) operable to allow fluid access when punctured by aneedle and to restrict fluid access in the absence of an engaged needle.

For some applications second end 62 of hub 60 may include flange 63. Thedimensions and configuration of second end 62 of hub 60 may be varied toaccommodate various insertion sites for an IO device. Hub 60 may beformed with a wide variety of flanges or other configurations compatiblewith contacting a patient's skin adjacent a desired insertion site.

Passageway 66 may extend from first end 61 through hub 60 to second end62. Portions of passageway 66 extending from second end 62 may havedimensions selected to be compatible with securely engaging exteriorportions of outer penetrator or cannula 70 with hub 60. Second end 72 ofcannula 70 may be disposed within passageway 66 between first end 61 andsecond end 62. First end 71 of cannula 70 may extend from second end 62of hub 60. Portions of passageway 66 extending from first end 61 of hub60 may have an enlarged inside diameter to accommodate attachment withvarious types of fluid connectors.

Cannula or outer penetrator 70 may have longitudinal bore 73 extendingfrom first end 71 to second end 72. Exterior dimensions of trocar orinner penetrator 42 are preferably selected to allow inner penetrator 42be inserted through outer penetrator 70 with first end 44 of innerpenetrator 42 generally aligned with first end 71 of outer penetrator 70after threads 67 have been engaged with threads 37.

Tip 71 of outer penetrator 70 and/or tip 44 of inner penetrator 42 maybe operable to penetrate bone and associated bone marrow. Theconfiguration of tips 71 and 44 may be selected to penetrate a bone,bone marrow and other portions of a patient's body with minimum trauma.For some applications tip 44 of inner penetrator 42 may have a generallytrapezoid shape with one or more cutting surfaces.

For some applications tips 71 and 44 may be ground together as a singleunit during an associated manufacturing process. Providing a matchingfit allows respective tips 71 and 44 to act as a single drilling unit tominimize damage as portions of IO needle set 40 are inserted into a boneand associated bone marrow.

Inner penetrator 42 may sometimes include a longitudinal groove (notexpressly shown) that runs along one side of inner penetrator 42 toallow bone chips and/or tissue to exit an insertion site as IO needleset 40 is drilled deeper into an associated bone. Outer penetrator 70and/or inner penetrator 42 may be formed from various materialsincluding, but not limited to, stainless steel, titanium or any othermaterial having suitable strength and durability to penetrate bone andassociated bone marrow. The combination of hub 60 with cannula 70 maysometimes be referred to as an “intraosseous needle.” The combination oftrocar 42 with cannula 70 may sometimes be referred to as a “penetratorset.”

Second end 62 and particularly flange 63 may be used to stabilize hub 60after insertion into a selected target area of a patient. Second end 32of connector 30 may be releasably engaged from first end 61 of hub 60after insertion of outer penetrator 70 into associated bone marrow. Thedepth of such insertion may be dependent upon the distance between tip71 of cannula 70 and second end 62 of hub 60. Various types of tubingand/or conduit may then be engaged with threads 67 formed on theexterior of hub 60 proximate first end or pin end 61.

Annular slot or groove 64 may be formed within second end 62 and sizedto receive one end of protective cover or needle cap 80. Slot or groove64 may be used to releasably engage cover 80 with hub 60. For someapplications cover 80 may be described as a generally hollow tube havingrounded end or closed end 82. Cover 80 may be disposed within annulargroove 64 to protect portions of outer penetrator 70 and innerpenetrator 42 prior to attachment with a manual driver or a powereddriver. Cover 80 may include a plurality of longitudinal ridges 84formed on the exterior thereof. Longitudinal ridges 84 may cooperatewith each other to allow installing and removing cover or needle cap 80without contaminating portions of an associated penetrator needle or IOdevice. Cover 80 may be formed from various types of plastics and/ormetals.

Canister 50 as shown in FIG. 4 may include lid 48. Lid 48 may beconfigured to allow lid 48 to be flipped open with one or more digits ofan operator's hand. With lid 48 open, an operator may releasably engagea driver with an IO device disposed in container. For example, connector20 of powered driver 10 may be releasably engaged with connectorreceptacle 34 of connector 30. Flexible connector 46 may be used toretain lid 48 with canister 50 after lid 48 has been opened.

FIGS. 5A and 5B show an intraosseous device inserted into bone andassociated bone marrow along with an attachment mechanism and a supportstructure incorporating teachings of the present disclosure. Variousfeatures of the present disclosure may also be discussed with respect tobone 148 and associated bone marrow 146 as shown in FIGS. 5A and 5B.Bone 148 and bone marrow 146 may be representative of a portion of apatient's upper arm or humeral head, but the teachings of the presentdisclosure are applicable to any suitable bone or bone marrow.

FIG. 5A shows an isometric view of one embodiment of an intraosseousdevice located in the humeral end of a patient and stabilized with asupport structure. In this embodiment, support structure 130 may includewings 136 and three tabs 134, tabs 134 including adhesive layers 138.Adhesive layers 138 may be disposed against a patient's skin 145 inposition to provide stability to hub 60. Wings 136 and tabs 134 may beformed from flexible material operable to conform with exterior portionsof hub 60 and/or the configuration of an insertion site.

FIG. 5A also shows connector assembly 90 may include any system ordevice configured to mate with hub 60 and complete a fluid network withthe interior of hub 60. For instance, connector assembly 90 may includeluer lock cap 140, right angle connector 142, and flexible tubing 100.In some embodiments, right angle connector 142 may comprise any hollowcomponent configured to complete a fluid network between the interior ofhub 60 and an external fluid source and/or receiver such as flexibletubing 100. For instance, right angle connector 142 may include rigidtubing, piping and/or other suitable conduits.

FIG. 5B shows a cross section of the embodiment depicted in FIG. 5A,taken along line 5B-5B. As shown in FIG. 5B, an intraosseous device maybe generally described as intraosseous (IO) needle 70 having a hollow,longitudinal bore 73 extending therethrough. First end or tip 71 of IOneedle 70 may be designed to drill or cut through bone 148 and penetrateassociated bone marrow 146. Tip 71 may be open to allow communication offluids with bone marrow 146.

FIG. 6 shows connector assembly 90 which may be used to communicatefluids with an intraosseous device in accordance with teachings of thepresent disclosure.

Connector assembly 90 may include any appropriate features or componentsselected to be compatible with external features of hub 60 or tubingextending therefrom. In some embodiments, such as that shown in FIG. 5A,connector assembly 90 may include internal threads 92 selected to becompatible with threads 67 disposed on hub 60.

Connector assembly 90 may also include any appropriate features orcomponents selected to facilitate attachment to any suitable connections(e.g., extension tubes) for fluid delivery or monitoring devices. Forexample, connector assembly 90 may include external threads 94 selectedto be compatible with a luer lock or other threaded connection.

Connector assembly 90 may include components intended to allow fluidaccess to hub 60 when appropriate connectors are present. For example,connector assembly may include plug 96. Plug 96 may be any compressiblematerial (e.g., rubber and/or synthetic rubber). In such embodiments,connector assembly 90 may be configured so that plug 96 is under atleast some compression in order to create a liquid seal against an innersurface of connector assembly 90. For example connector assembly 90 mayinclude a Halkey-Roberts luer activated valve. One having ordinary skillin the art may recognize additional traditional medical equipment thatmay be compatible with the IO devices described herein.

FIG. 7 shows Automatic External Defibrillator 110 which may be used totreat a patient exhibiting cardiac arrhythmia in accordance withteachings of the present disclosure. AED 110, as shown in FIG. 7, mayinclude attachable electrodes 112, controls 114, logic processor 115,handle 116 and display 118. AED may be automatic or semi-automatic andmay be operable to deliver defibrillating shock under appropriateconditions.

Electrodes 112 may include any suitable means for providing theappropriate connection to patient 104. For example, electrodes 112 mayinclude electrode pads and/or other connectors. Electrodes 112 may beoperable to measure a patient's heart rhythms, blood pressure, and/orany other appropriate indicator of patient health.

Controls 114 may include any device configured to allow user 106 tooperate AED 110. In embodiments such as that shown in FIG. 7, controls114 may include depressible buttons. In other embodiments, controls 114may include any input device (e.g., switches, touchpads, and/or dials).

Logic processor 115 may include any device or devices for processingsignals received from electrodes 112 (e.g., converting analog signals todigital signals, and/or interpreting identifiers (e.g., serial numbers,device codes and/or other codes) of various components in AED 110). Forexample, logic processor 115 may include a device configured to receivea signal generated by electrodes 112, analyze the received signal,and/or convert the signal to a format suitable for communication to user106. Logic processor 115 may include any suitable hardware or software(e.g., any suitable software, algorithms, or other logic orinstructions).

Handle 116 may include any feature of AED 110 that allows user 106 tograsp or manipulate AED 110. In embodiments such as that shown in FIG.7, handle 116 may include an extension of the shell encasing AED 110 asa whole. In other embodiments, handle 116 may include a strap, anindention of the shell of AED 110, and/or any other physical featureconfigured to allow user 106 to grasp AED 110.

Display 118 may include any component of AED 110 configured tocommunicate instructions to user 106. In embodiments such as that shownin FIG. 7, display 118 may include a screen operable to display textcommands to user 106. For example, display 118 may include an LCD, aplasma display, a set of LEDs, a segment display, a cathode ray tube,and/or any other useful means of displaying information. Display 118 maybe operable to instruct user 106 regarding proper installation ofelectrodes 112, proper treatment of patient 104, and/or any otherinformation useful in the treatment of patient 104.

FIGS. 8A and 8B show one method for treating patient 104 in accordancewith teachings of the present disclosure. At step 1, shown in FIG. 8A,user 106 may determine that patient 104 is the subject of an unknownmedical condition that may include a cardiac condition. User 106 mayfurther dispose AED 110 proximate to patient 104. User may furtheroperate latch 108 to open the lid of AED 110. Latch 108 may include anydevice operable to provide access to working portions of AED 110.

At step 2, shown in FIG. 8A, user 106 may read or otherwise followdirections or instructions 119 provided by AED 110. Instructions 119 mayinclude any elements of a treatment protocol, such as ACLS protocol,and/or other instructions preparatory to delivering treatment. Forexample, in embodiments such as that shown in FIGS. 8A and 8B,instructions 119 may include directives to remove the portion ofpatient's 104 clothing over his/her chest. In other embodiments,instructions 119 may include directives to check patient 104 forresponsiveness, a carotid pulse, or other indicator of the medicalcondition of patient 104. In some embodiments, instructions 119 mayinclude directives to make contact with Emergency Medical Services orother personnel. In embodiments such as that shown in FIG. 8A and 8B,instructions 119 may include directives to prepare and place electrodes112 in appropriate locations relative to patient 104.

At Step 3, shown in FIG. 8B, AED 110 may have completed analysis ofcardiac indicators of patient 104. Such indicators may include, but arenot limited to, blood pressure, heart rhythms, and/or any othermeasurable quantity or quality related to the cardiac system of patient104. AED 110 may collect relevant data through electrodes 112, shown inFIG. 8B as attached to the chest of patient 104 via leads 113. In otherembodiments, AED 110 may collect relevant data through any combinationof sensors operable to deliver a signal to AED 110.

AED 110, as discussed in relation to FIG. 7, may include a display orother component intended to communicate instructions 119 to user 106. Inembodiments such as that shown in FIG. 8B, AED 110 may include a soundrecording instructing user 106 to activate a shock to defibrillatepatient's 104 heart. User 106 may comply with that instruction bypressing button 114, or any other actuator or switch provided by AED110. AED 110 may also provide additional directives, such as aninstruction to ensure no one is in physical contact with patient 104.

FIG. 9A illustrates one example of an intraosseous device placement kit120 in accordance with teachings of the current disclosure. FIG. 9Bshows a close-up of one feature that might be included in embodimentssuch as that shown in FIG. 9A. Kit 120 may include a case and/or bagconfigured to house and/or transport implements, tools, and/or othermaterial that might be useful in placing an IO device in accordance withteachings of the present disclosure. In embodiments such as that shownin FIG. 9A, kit 120 may include first side 122, second side 124, handle121, and zipper 126.

Handle 121 may include any device, feature or characteristic of kit 120configured to facilitate grasping or manipulation of kit 120 by user106. For example, handle 121 may include a depression in the body of kit120 configured to fit user's 106 hand or fingers, a separate piece ofmaterial attached to the body of kit 120, or an extension of some partof the body of kit 120. In examples such as that shown in FIG. 9A,handle 121 may include a rugged piece of material (e.g., fabric,plastic, metal, and/or any other suitable material) attached to secondside 124 of kit 120.

Kit 120 may include first side 122 and second side 124 configured tocontain and/or protect the components within kit 120. Kit 120 may alsoinclude any combination configured to allow user 106 to access thecomponents within kit 120. For example, in embodiments such as thatshown in FIG. 9A, kit 120 may include a generally block-shaped box withfirst side 122 including some fraction of the total box and second side124 including the remaining portion of the total box. The interiorvolume of each side may be configured to house the components within kit120. At the same time, the separation of first side 122 from second side124 may allow user 106 to access the components.

Zipper 126 may include any component or device configured to releasablyjoin first side 122 with second side 124. Zipper 126 may includefeatures or designs configured to interact with user's 104 fingers orhands to facilitate the user 104 opening kit 120. In embodiments such asthat shown in FIG. 9A, opening kit 120 may consist of operating zipper126 to allow separation of first side 122 from second side 124. In suchembodiments, zipper 126 may include pulls 127, tabs or other componentsconfigured to facilitate the operation of zipper 126. In otherembodiments, opening kit 120 may consist of operating any sort ofconnector (e.g., a clasp, buckles, straps, velcro-brand hook and loopfasteners, and/or any other releasable connector).

FIG. 9B shows a close-up of one portion of kit 120. Kit 120 may includelatch 128. Latch 128 may include any device or mechanism configured torestrict accidental, inadvertent or unauthorized operation of zipper126. In embodiments such as that shown in FIG. 9B, zipper 126 mayinclude latch 128. Latch 128 may be configured to restrict theaccidental or inadvertent separation of pulls 127. In addition, latch128 may be configured to open or release with minimal effort by user104, such as by pulling or squeezing latch 128 (e.g., as is present inconventional devices like some keyrings, carabineers, and/or any otherquick-release mechanism).

FIG. 10A shows a schematic drawing of kit 120 in the open state,including interior features. Kit 120 may include IO driver bracket 160,interior partition 170, and/or assorted pockets and features configuredto store or contain items useful in the installation of an intraosseousdevice. Persons having ordinary skill in the art will recognize that theinterior of kit 120 may be configured or constructed from a wide varietyof materials and in a wide variety of shapes and sizes as appropriatefor the items intended to be placed in kit 120. Although the interior ofkit 120 is herein described with respect to the embodiment shown inFIGS. 10A and 10B, the teachings of the present disclosure are notlimited to such embodiments.

Bracket 160 may include any component or device configured to releasablystore powered driver 10 or manual driver 10 a and/or any other deviceconfigured to facilitate insertion of an intraosseous device. Bracket160 may include extended sides 162, cradle 164, base 166, and connectors168. Bracket 160 may be fabricated from extruded plastic, moldedplastic, wood, and/or any other material suitable for forming thedesired shape. In some embodiments, bracket 160 may include elasticstraps, and/or any combination of straps and fasteners (e.g., Velcro,hooks, buckles, etc.).

Extended sides 162 may include any feature of bracket 160 configured toextend from the main body of bracket 160. In embodiments such as thatshown in FIG. 10A, extended sides 162 may include basically planarbodies as well as lip 163 and/or other feature. Lip 163 may include anyfeature of extended sides 162 configured to snap on to or grip driver 10and to withstand incidental and/or inadvertent forces applied to driver10.

Cradle 164 may include any component or feature of bracket 160configured to conform or otherwise interact with handle 16 of driver 10.Cradle 164 may include a shape substantially matching handle 16 for onespecific driver 10 or it may include a general shape configured tointeract with a wide variety of drivers 10.

Base 166 may include any component or feature of bracket 160 configuredto provide attachment points between bracket 160 and the interior of kit120. In embodiments such as that shown in FIG. 10A, bracket 160 may befastened to second side 124. In other embodiments, bracket 160 may beattached to any other feature or part of kit 120. In addition, bracket160 may be formed monolithically with one or more portions of kit 120and may not include base 166 at all.

Connectors 168 may include any device or component configured to connectbase 166 and/or bracket 160 to kit 120. Connectors 168 may includepermanent connectors (e.g., rivets, and/or nails) or may includereleasable and reusable fasteners (e.g., bolts, screws, and/or studs).In embodiments such as that shown in FIG. 10A, connectors 168 mayinclude rivets and washers permanently fastening bracket 160 within kit120.

Interior partition 170 may include any component or feature of kit 120operable to segregate interior compartments of kit 120. In addition,interior partition 170 may be configured to store devices or componentsof an IO installation device. In embodiments such as that shown in FIG.10A, interior partition 170 may include divider 172, flexible connector174, pockets 176 and loops 178.

Divider 172 may include any feature or component of interior partition170 configured to separate one interior portion of kit 120 from another.For example, divider 172 may include a sheet of sturdy flexiblematerial. In other embodiments, divider 172 may include a rigid divider,a lid for one or more interior compartments, or similar structure.

Flexible connector 174 may include any feature or component of interiorpartition 170 configured to allow relative motion between interiorpartition 170 and kit 120. For example, flexible connector 174 mayinclude a strip of fabric or plastic. In other examples, flexibleconnector 174 may include an articulate component (e.g., a hinge, clevispin, and/or other joint).

Pockets 176 may include any feature or component of interior partition170 configured to house or contain devices or component configured tofacilitate the insertion or use of an IO device in accordance withteachings of the present disclosure. In embodiments such as that shownin FIG. 10A, pockets 176 may include portions of fabric, plastic oranother material connected to interior partition 170 and configured toallow insertion and removal of devices, paper, cards, or other usefulitems. For example, pockets 176 may include compartments configured toallow the insertion and removal of index cards or pre-printed cards withinstructions for use or other useful information.

Loops 178 may include any component or feature of interior partition 170configured to releasably hold components of IO insertion devices or kit120. For example, loops 178 may include strips of elastic materialconfigured to stretch for insertion of components and retract to holdthose components securely. In some embodiments, loops 178 may includefabric or plastic material. Persons having ordinary skill in the artwill recognize that loops 178 and pockets 176 may be made of any size,shape and configuration appropriate to house any device or componentsuitable for kit 120.

FIG. 10B shows a close-up view of bracket 160 along with driver 10. FIG.10B depicts one embodiment of powered driver 10 present and storedwithin bracket 160. In embodiments such as that depicted in FIG. 10B,bracket 160 may be configured to conform closely to the shape anddimensions of powered driver 10 and specifically, to handle 16. Extendedsides 162 may be configured to protrude from base 166 and enclose asignificant portion of handle 16. In addition, extended sides 162 mayinclude lips 163 configured to restrict handle 16 from separation frombracket 160. In such embodiments, lips 163 may be configured to protrudeabove handle 16 when driver 10 may be present in bracket 160. In otherembodiments, lips 163 may be configured to interface with one or morefeatures of handle 16 to provide a physical stop. In such embodiments,the physical resistance to motion may be configured to resist incidentalor inadvertent forces but to yield easily to purposeful removal ofdriver 10.

FIG. 11 shows an example of kit 120 in accordance with teachings of thecurrent disclosure, depicting driver 10 present in bracket 160. Inaddition, FIG. 11 depicts components configured to facilitate providingan electric charge to driver 10 while present in bracket 160. Kit 120may include charger 180, cord 182, power indicator 184, and chargingindicator 186.

Charger 180 may include any device or component configured to provide anelectrical connection between an external source of electricity anddriver 10. For example, charger 180 may include an AC/DC converter,electric contacts, or any other components useful in supplying power todriver 10.

Power cord 182 may include any device or component configured to connectcharger 180 to an external source of power. For example, power cord 182may include cable, wire, conductors and/or any peripheral devices usefulfor creating an electrical connection such as a two- or three-prongplug.

In embodiments such as that shown in FIG. 11, charger 180 may includepower indicator 184 and charging indicator 186. Such indicators arewell-known in applications for rechargeable household appliances such ascordless telephones, wireless shavers, and the like. In suchembodiments, power indicator 184 may include an LED that emits greenlight when charger 180 is connected to an active power source. In suchembodiments, charging indicator 186 may include an LED that emits redlight when driver 10 is accumulating an electrical charge.

FIG. 12 is a depiction of an embodiment of apparatus 200 combining AED110 and IO installation kit 120 in accordance with teachings of thepresent disclosure. In such embodiments, apparatus 200 may includeelectrodes 112, electrode port 202, display 204, controls 206, processor208, driver cradle 210, drug delivery slot 220, and drug delivery port230. In other embodiments, not all of these features may be present.

Electrodes 112, as described in more detail with relation to FIG. 7, mayinclude any device configured to releasably connect apparatus 200 withpatient 104 and operable to collect cardiac information from patient104.

Electrode port 202 may include any connector configured to connectelectrodes 112 with processor 208 both physically and for the transferof data. For example, electrode port 202 may include, e.g., a twist-onwire connector, terminals, terminal blocks, banana plugs, crimp-onterminals, lugs, plug and socket connectors, DIN connector,D-subminiature plugs, registered jack and/or any other suitableconnectors.

Display 204 may include any device or component operable to communicatedata or instructions to user 106. For example, display 204 may include aLCD screen or touchpad such as those used in laptop computers. In otherexamples, display 204 may include a plasma display, a set of LEDs, asegment display, a cathode ray tube, and/or any other useful means ofdisplaying information. Display 204 may be operable to instruct user 106regarding proper installation of electrodes 112, proper treatment ofpatient 104, and/or any other information useful in the treatment ofpatient 104.

Controls 206 may include any device configured to allow user 106 tooperate apparatus 200. In embodiments such as that shown in FIG. 12,controls 206 may include depressible buttons. In other embodiments,controls 206 may include any similar input device (e.g., switches,touchpads, and/or dials). As example functions, controls 206 may beoperable to indicate electrodes 112 have been attached to patient 104,to query processor 208, to activate a defibrillating shock, to deliverdrugs or medication present in drug delivery slot 220, or any otherfunction useful in practicing the teachings of the present disclosure.

Processor 208 may include any device or devices for processing signalsreceived from electrodes 112 (e.g., converting analog signals to digitalsignals, and/or interpreting identifiers (e.g., serial numbers, devicecodes and/or other codes) of various components in apparatus 200). Forexample, processor 208 may include a device configured to receive asignal generated by electrodes 112, analyze the received signal, and/orconvert the signal to a format suitable for communication to user 106.Processor 208 may include any suitable hardware or software (e.g., anysuitable software, algorithms, or other logic or instructions).

Driver cradle 210 may include any feature or component of apparatus 200configured to releasably contain driver 10 or manual driver 10 a. Insome embodiments, driver cradle 210 may include any features of bracket160 discussed in relation to FIG. 10A. In other embodiments, such asthat shown in FIG. 12, driver cradle 210 may include sidewalls 212 andbottom 214.

Sidewalls 212 may include any feature or component of apparatus 200configured to releasably hold driver 10 or manual driver 10 a until user106 prepares to install an IO device. Sidewalls 212 may be configured tohold driver 10 with IO needle set 40 connected to driver 10 or withoutIO needle set 40 connected to driver 10. In some embodiments, such asthat shown in FIG. 12, sidewalls 212 may include smooth and flat panelsas in commonly available phone handset cradles.

Likewise, bottom 214 may include any configuration suitable forreleasable storage of driver 10 or manual driver 10 a. For example,bottom 214 may include a substantially flat, smooth portion of apparatus200. As another example, bottom 214 may include indentions andprotrusions configured to interface with features or components ofdriver 10 and/or manual driver 10 a. In some embodiments, bottom 214 mayinclude features or components operable to deliver an electric charge toa battery or power source within driver 10.

Drug delivery slot 220 may include any feature or component of apparatus200 configured to receive an infusion of medication or drugs preparatoryto delivery to patient 104. In some embodiments, such as that shown inFIG. 12, drug delivery slot may be configured to accept and dispensedrugs stored in cartridges 226. In such embodiments, drug delivery slot220 may include top 222 and sidewalls 224. Drug delivery slot 220 mayinclude any features or devices configured to delivery drugs and/ormedication from cartridge 226 to drug delivery port 230 and to apatient, e.g., through flexible tubing 100 and connector assembly 90 toan IO device. In some embodiments, drug delivery slot 220 may includefeatures for accepting a plurality of cartridges 226. For example, drugdelivery slot 220 may include six slots for accepting unit dosecartridges of drugs used in the practice of ACLS.

Top 222 may include any feature or component of drug delivery slot 220configured to adapt to cartridge 226. For example, top 222 may includedevices configured hold cartridge 226 by operating in a similar manneras a battery retainer in a conventional handheld electronic device. Inother embodiments, top 222 may include a flexible protrusion configuredto create a friction fit with cartridge 226, an extension configured toprotrude above cartridge 226 when cartridge 226 is present in drugdelivery slot 220, or any other feature configured to hold cartridge 226in place until user 106 desires to remove cartridge 226.

Sidewalls 224 may include any feature or component of drug delivery slot220 configured to adapt to cartridge 226. For example, sidewalls 224 mayinclude devices configured hold cartridge 226 by operating in a similarmanner as a battery retainer in a conventional handheld electronicdevice. In other embodiments, sidewalls 224 may include a flexibleprotrusion configured to create a friction fit with cartridge 226, anextension configured to protrude above cartridge 226 when cartridge 226is present in drug delivery slot 220, or any other feature configured tohold cartridge 226 in place until user 106 desires to remove cartridge226.

Storage slots 232 may include any feature or component of apparatus 200configured to releasably hold cartridge 226. For example, storage slot232 may include a cylindrical socket in the body of apparatus 200 shapedto provide a snug fit around cartridge 226. In some embodiments, storageslots 232 may be located in the side, top, or bottom of apparatus 200.In other embodiments, cartridges 226 may be stored in kit 120 or pockets174 and loops 176 associated with apparatus 200.

In other embodiments, drug delivery slot may be configured to receivedrugs without interface with cartridge 226. For example, drug deliveryslot 220 may include a rubber gasket suitable for puncture by ahypodermic needle.

Drug delivery port 230 may include any feature or component of apparatus200 configured to provide an interface between drug delivery slot 220and flexible tubing 100 and connector assembly 90 (discussed in relationto FIGS. 5 and 6). For example, drug delivery port 230 may include aluer lock connection. Drug delivery port 230 may include any otherappropriate joint (e.g., a valve, a threaded fitting, a plug and socket,and/or any component appropriate to provide a fluid connection betweenapparatus 200 and patient 104).

FIGS. 13A and 13B show examples of cartridges which may be used withmedical apparatus incorporating teachings of the present disclosure.Cartridges 226 a and 226 b may include any device configured to store amedication or drug and interface with apparatus 200. Cartridges 226 aand 226 b may be configured to fit in storage slots 232 as well as drugdelivery slot 220. Cartridges 226 a and 226 b may include a canister, avial, a syringe, and/or any other pre-filled sterile containerappropriate for the storage of medications and/or drugs. In someembodiments, cartridges 226 a and 226 b may include a known single unitdose drug cartridge. In some embodiments, cartridges 226 a and 226 b mayinclude a marker identifying the contents of cartridges 226 a and 226 b(e.g., color-coding, text, chemical formulations, and/or any otherinformation that may be used to indicate the contents of cartridges 226a and 226 b to a user).

In other embodiments, such as those shown in FIGS. 13A and 13B,cartridges 226 a and 226 b may include multiple chambers 240 a and 240b. In such embodiments, each chamber may be configured to hold a singledose of a medicine, drug, and/or a flushing solution. In suchembodiments, drug delivery slot 220 may include any features and/ordevices configured to select a chamber, provide a fluid connectionbetween the chamber and drug delivery port 230, deliver fluid from thechamber to drug delivery port 230 and then to a patient (e.g., viaflexible tubing 100, connector assembly 90 and an IO device). Thoseembodiments of cartridges 226 a and 226 b with multiple chambers mayinclude a rotating component that alternates drug chambers with chambersfilled with sterile solutions. In such embodiments, drug delivery slot220 may inject fluid from the chambers filled with sterile solutionafter injecting fluid from a drug chamber to flush drug delivery port230, flexible tubing 100, connector assembly 90, and/or an IO device.

As shown in FIG. 13A, cartridge 226 a may have a generally cylindricalconfiguration with rigid walls. Chambers 240 a may be disposed around acentral axis 242. In such embodiments, each chamber 240 a may be filledwith a single dose of a drug, medication, and/or sterile flushing fluid.In such embodiments, drug delivery slot 220 may include any necessarycomponents or features configured to deliver the contents of eachchamber 240 a and to rotate cartridge 226 a around axis 242 as needed toaccess each chamber 240 a.

FIG. 13B shows another embodiment of cartridge 226 b including multiplechambers 240 b. Cartridge 226 b may have a generally rectangularconfiguration with relatively rigid walls. Alternatively, cartridge 226b may be formed from relatively flexible material to accommodatestorage, insertion, and removal from an associated medical device and/orapparatus.

Cartridge 226 may include one or more chambers 240 b disposed along thelength of cartridge 226. In such embodiments, each chamber 240 b may befilled with a single unit dose of drug, medication and/or sterileflushing solution. In such embodiments, drug delivery slot 220 mayinclude any necessary components or features configured to deliver thecontents of each chamber 240 b as needed by apparatus 200.

FIG. 14 depicts one embodiment of apparatus 200 in accordance withteachings of the present disclosure. In embodiments such as that shownin FIG. 12, apparatus 200 may include the features previously discussedin relation to kit 120 and AED 110. Such embodiments may include driver10, electrodes 112, interior partition 170, charger 180, electrode port202, display 204, controls 206, processor 208, driver cradle 210, drugdelivery slot 220, and drug delivery port 230. Such embodiments mayprovide a single kit operable to perform the functions previouslydescribed in relation to AED 110 and kit 120.

FIG. 15 shows a flowchart depicting a method 300 of treating patient 104by user 106 including apparatus 200, a combination AED and IO drugdelivery kit, in accordance with teachings of the present disclosure. Atstep 310 patient 104 may be identified, which may include recognizingphysical signs of distress, hearing a call for help, responding to acall for emergency services, or any other process capable of identifyingpatient 104.

At step 320, the lack of responsiveness of patient 104 may be confirmed.Step 320 may include performing preliminary diagnosis, asking questions,receiving information from witnesses and/or bystanders, and/or any othersuitable procedure intended to confirm the condition of patient 104.

At step 330, apparatus 200 may be engaged for the treatment of patient104. Engagement of apparatus 200 may include opening apparatus 200 toexpose display 204, controls 206 and/or instructions. Engagement ofapparatus 200 may be retrieved from a wall-mount, an emergency vehicle,a supply of medical equipment, and/or any other storage facility ortransport equipment suitable for carrying or storing apparatus 200.Engagement of apparatus 200 may include following any directions orinstructions included with apparatus 200 or provided by display 204.

At step 340, electrodes 112 may be applied to patient 104. Applicationof electrodes 112 may include removal of clothing or other obstacles tothe chest of patient 104. Application of electrodes 112 may includereleasably connecting electrodes 112 to appropriate portions ofpatient's 104 skin.

At step 350, apparatus 200 may be activated. In some embodiments,activation of apparatus 200 may include operation of controls 206. Inother embodiments, activation of apparatus 200 may include apparatus 200sensing that electrodes 112 are in place and automatically engaging inanalysis of any data gathered. Activation of apparatus 200 may includeswitching apparatus 200 on and/or any other method of activating thepower circuitry of apparatus 200.

At step 360, a recommended treatment protocol may be followed. In someembodiments, recommended treatment protocol may include ACLS treatmentprotocol for cardiac arrhythmia. Following a recommended treatmentprotocol may include responding to directions or instructions providedby apparatus 200, communicated on display 204, and/or any other methodof instructing user 106.

At step 370, IO needle set 40 may be inserted into the vascular systemof patient 104. Insertion of IO needle set 40 may be a part ofinstructions or directions provided by apparatus 200. Insertion of IOneedle set 40 at step 370 may include the use of any of the IO insertioncomponents discussed in the present disclosure. Insertion of IO needleset 40 may include connecting apparatus 200 to flexible tubing 100 viadrug delivery port 230 or any other component providing access to thevascular system of patient 104.

At step 380, drugs or medication may be administered to patient 104.Administration of drugs may be as a response to instructions ordirections provided by apparatus 200. Administration of drugs mayinclude insertion of cartridge 226 into drug delivery slot 220 and/orany other means of communicating drugs from apparatus 200 to patient104. Administration of drugs may be accomplished by user 106 activationof control 206 or may include an automatic function of apparatus 200upon analysis of data collected via electrodes 112. In some embodiments,apparatus 200 may administer drugs without user interaction, e.g.,automatically delivering drugs from a multi-chamber drug cartridge 226.In such embodiments, apparatus 200 may administer a first drug from onechamber followed by a flushing solution from a second chamber ofcartridge 226.

At step 390, defibrillating shock may be administered to patient 104.Administration of defibrillating shock may be as a response toinstructions or directions provided by apparatus 200. Administration ofdefibrillating shock may be accomplished by user 106 activation ofcontrol 206 or may include an automatic function of apparatus 200 uponanalysis of data collected via electrodes 112.

Although the present disclosure and its advantages have been describedin relation to intraosseous devices, it should be clear to a personhaving ordinary skill in the art that these teachings can be applied tosupport a variety of medical devices in relation to a patient. Forexample, embodiments of the present disclosure might be utilized toprovide fluid to any intravenous connection or device, a central line,an endotracheal tube, a chest tube, a catheter, dialysis tubing and/orany other device intended to make a fluid connection to one or moresystems of the patient.

Examples of acute and chronic conditions which may be treated usingintraosseous devices and procedures incorporating teachings of thepresent disclosure include, but are not limited to, the following:

-   -   Anaphylaxis (epinephrine, steroids, antihistamines, fluids, and        life support)    -   Arrhythmia (anti-arrhythmics, electrolyte balance, life        support);    -   Burns (fluid replacement, antibiotics, morphine for pain        control);    -   Cardiac arrest (epinephrine, atropine, amiodarone, calcium,        xylocaine, magnesium);    -   Congestive heart failure (life support, diuretics, morphine,        nitroglycerin);    -   Dehydration (emergency port for life support, antibiotics,        blood, electrolytes);    -   Diabetic Ketoacidosis (life support, electrolyte control, fluid        replacement);    -   Dialysis (emergency port for life support, antibiotics, blood,        electrolytes);    -   Drug overdose (naloxone, life support, electrolyte correction);    -   Emphysema (life support, beta adrenergics, steroids);    -   Hemophiliacs (life support, blood, fibrin products, analgesics);    -   Osteomyelitis (antibiotics directly into the site of infection,        analgesics);    -   Pediatric applications (shock, dehydration, nutrition,        electrolyte correction);    -   Seizures (anti-seizure medications, life support, fluid        balance);    -   Shock (life support fluids, pressor agents, antibiotics,        steroids);    -   Sickle cell crisis (fluid, morphine for pain, blood,        antibiotics, exchange transfusion);    -   Trauma (emergency port for life support fluids, antibiotics,        blood, electrolytes);

Although the present disclosure and its advantages have been describedin detail, it should be understood that various changes, substitutionsand alternations can be made herein without departing from the spiritand scope of the disclosure as defined by the following claims.

1. Medical apparatus for treating a patient comprising: two electrodes,the two electrodes including an attachment operable to releasablyconnect the two electrodes to the patient; a processor operable tocollect and analyze a rhythm associated with the patient's heart fromthe two electrodes; a display operable to communicate instructions to auser; an intraosseous device and a driver operable to insert theintraosseous device into a bone and associated bone marrow of thepatient; a drug delivery slot having at least one dose of a drugdisposed therein; a drug delivery port operable to communicate the drugfrom the drug delivery slot to the patient via the intraosseous device;and a voltage source operable to deliver an electric shock to thepatient via the two electrodes; and a housing configured to house theprocessor, the display, the drug delivery slot, the drug delivery portand the voltage source.
 2. The medical apparatus of claim 1 furthercomprising: the processor operable to analyze the rhythm based on theAdvanced Cardiac Life Support protocol; and the drug delivery portoperable to communicate the drug as prescribed based on the AdvancedCardiac Life Support protocol.
 3. The medical apparatus of claim 1further comprising a rechargeable power supply operable to energize theprocessor, the display, and the voltage source.
 4. The medical apparatusof claim 1 wherein the driver comprises a battery power supply.
 5. Themedical apparatus of claim 1 comprising the processor operable toactivate the voltage source.
 6. The medical apparatus of claim 1 whereinthe housing further comprises a cradle configured to releasably hold thedriver.
 7. The medical apparatus of claim 1 wherein the housing furthercomprises one or more storage slots configured to releasably hold a drugcontainer.
 8. The medical apparatus of claim 1 further comprising: thedriver including a rechargeable power supply; and the housing includinga charger operable to supply power to the rechargeable power supply. 9.The medical apparatus of claim 1 further comprising the drug deliveryslot operable to receive a drug cartridge comprising at least two singleunit dose chambers.
 10. The medical apparatus of claim 9 furthercomprising the drug delivery slot operable to receive a drug cartridgecomprising at least two single unit dose chambers surrounding a centralaxis.
 11. Medical apparatus for treatment of a patient, the apparatuscomprising: an intraosseous device operable to penetrate a bone andassociated bone marrow; a cartridge including multiple chambers operableto hold a single dose of one or more drugs; a drug delivery portoperable to communicate the one or more drugs from the multiple chambersin the cartridge to the patient via the intraosseous device; a processoroperable to collect and analyze a rhythm associated with the patient'sheart; a display operable to communicate one or more instructions to auser in relation to treatment of the patient; a voltage source operableto deliver a defibrillating shock to the patient; and one or moreinstructions with directions to administer the one or more drugs to thepatient via the intraosseous device.
 12. The apparatus of claim 11further comprising two electrodes operable to communicate the rhythm tothe processor.
 13. The apparatus of claim 11 further comprising theprocessor operable to activate the voltage source.
 14. The apparatus ofclaim 11 wherein the one or more instructions include elements ofAdvanced Cardiac Life Support protocol.
 15. The apparatus of claim 11wherein: the cartridge comprises a cylindrical drug cartridge having alongitudinal axis and at least two single unit dose chambers disposedgenerally parallel to the longitudinal axis such that each single unitdose chamber may be accessed by rotating the cartridge around thelongitudinal axis; and each unit dose chamber is operable to communicatewith the intraosseous device via the drug delivery port after the unitdose chamber has been accessed by rotating the cartridge.
 16. Theapparatus of claim 15 further comprising at least six single unit dosechambers disposed generally parallel to the longitudinal axis.
 17. Amethod for treating a patient comprising: disposing two electrodes onthe chest of the patient; activating an apparatus operable to collectand analyze a rhythm associated with the patient's heart; receiving oneor more instructions from the apparatus; inserting an intraosseousdevice into the patient's vascular system in response to the one or moreinstructions; automatically, without user interaction, administering adrug to the patient via the intraosseous device in response to the oneor more instructions; and administering a defibrillating shock to thepatient in response to the one or more instructions.
 18. The method ofclaim 17 wherein the apparatus provides the one or more instructionsbased on Advanced Cardiac Life Support protocol.
 19. The method of claim17 wherein the apparatus comprises a voltage source operable toadminister the defibrillating shock via the two electrodes.
 20. Themethod of claim 17 wherein the method further comprises connecting theintraosseous device to a drug delivery port associated with theapparatus.
 21. The method of claim 17 wherein the method furthercomprises administering a defibrillating shock to the patient afteradministering a drug to the patient.